Provider Demographics
NPI:1093704074
Name:ROBERTS, DEBRA WOOD (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:WOOD
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-1824
Mailing Address - Country:US
Mailing Address - Phone:651-429-6997
Mailing Address - Fax:
Practice Address - Street 1:10721 SMETANA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-8080
Practice Address - Country:US
Practice Address - Phone:952-936-9215
Practice Address - Fax:952-936-9942
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN64-11028OtherMEDICA
MNHP 31033OtherHEALTH PARTNERS
MN12859ROOtherBC/BS